| Prognostic value of systemic endothelial dysfunction in patients with acute coronary syndromes: further evidence for the existence of the "vulnerable" patient. | |
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MedLine Citation:
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PMID: 15451794 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Endothelial vasodilator dysfunction may serve as a marker integrating the vascular risk of an individual; however, whether systemic vasodilator function predicts disease progression and cardiovascular event rates in patients with manifest acute coronary syndromes (ACS) is unknown. METHODS AND RESULTS: In 198 patients with angiographically documented ACS, forearm blood flow (FBF) responses to acetylcholine (ACH; 10 to 50 microg/min) and sodium nitroprusside (SNP; 2 to 8 microg/min) were measured by venous occlusion plethysmography before hospital discharge within 5 days of an episode of an ACS. Cardiovascular events (cardiovascular death, myocardial infarction, and ischemic stroke) served as outcome variables over a mean follow-up period of 47.7+/-15.1 months. Patients who experienced cardiovascular events during follow-up (n=31) had a significantly reduced vasodilator response to ACH (P<0.05) and SNP (P<0.05). By multivariate analysis, vasodilator response to ACH and elevated troponin T serum levels were the only significant (P<0.05) independent predictors of a poor prognosis, even after adjustment for traditional cardiovascular risk factors, concurrent medication, invasive treatment strategy, and C-reactive protein serum levels. Recovery of endothelium-dependent vasoreactivity as assessed by repeated FBF assessment 8 weeks after the index measurement after the ACS predicted further event-free survival in a subset of 78 patients. CONCLUSIONS: Systemic endothelium-dependent vasoreactivity predicts recurrence of instability and cardiovascular event rates in patients with ACS. Furthermore, the recovery of systemic endothelial function is associated with event-free survival. Assessment of systemic vasoreactivity, measured by a minimally invasive test, provides important prognostic information in addition to that derived from traditional risk factor assessment in patients with ACS. |
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Authors:
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Stephan Fichtlscherer; Susanne Breuer; Andreas M Zeiher |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2004-09-27 |
Journal Detail:
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Title: Circulation Volume: 110 ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2004 Oct |
Date Detail:
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Created Date: 2004-10-06 Completed Date: 2005-05-27 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: United States |
Other Details:
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Languages: eng Pagination: 1926-32 Citation Subset: AIM; IM |
Affiliation:
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Department of Internal Medicine IV, Division of Cardiology, Johann W. Goethe University, Theodor Stern Kai 7, D-60590 Frankfurt, Germany. fichtlscherer@em.uni-frankfurt.de. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Acetylcholine
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diagnostic use* Acute Disease Adult Aged Biological Markers Brain Ischemia / epidemiology C-Reactive Protein / analysis Cohort Studies Disease Progression Disease-Free Survival Endothelium, Vascular / drug effects, physiopathology* Female Follow-Up Studies Forearm / blood supply Humans Life Tables Male Middle Aged Multivariate Analysis Myocardial Infarction / epidemiology Myocardial Ischemia / blood, mortality, physiopathology* Nitroprusside / diagnostic use* Plethysmography Predictive Value of Tests Prognosis Risk Factors Troponin T / blood Vasculitis / blood, complications, physiopathology Vasodilation / drug effects* Vasodilator Agents / diagnostic use* |
| Chemical | |
Reg. No./Substance:
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0/Biological Markers; 0/Troponin T; 0/Vasodilator Agents; 15078-28-1/Nitroprusside; 51-84-3/Acetylcholine; 9007-41-4/C-Reactive Protein |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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